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General NPI Number Information
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NPI Number | 1063093284
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Entity Type | Individual
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Provider Name | SHILPA RAVEENDRAN MENON DDS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 11/19/2023
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Provider Practice Location Address
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Address Line | 1702 MIRAMONTE AVE STE A
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3773
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Country | US
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Telephone | 650-988-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 20380 STEVENS CREEK BLVD APT 210
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City | CUPERTINO
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State | CA
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Zip | 95014-2272
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Country | US
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Telephone | 408-507-2490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS105697
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License Number State | CA
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